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Handelsman Y, Bunch TJ, Rodbard HW, Steinberg BA, Thind M, Bigot G, Konigsberg L, Wieloch M, Kowey PR. Impact of dronedarone on patients with atrial fibrillation and diabetes: A sub-analysis of the ATHENA and EURIDIS/ADONIS studies. J Diabetes Complications 2022; 36:108227. [PMID: 35717354 DOI: 10.1016/j.jdiacomp.2022.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/27/2022]
Abstract
AIM This post hoc analysis evaluated efficacy and safety of dronedarone in atrial fibrillation (AF) and atrial flutter (AFL) patients with/without diabetes. METHODS Patients were categorized according to baseline diabetes status. Time-to-event analyses were performed using Kaplan-Meier method. Hazard-ratios were assessed using Cox models. RESULTS 945/4628 (dronedarone = 482; placebo = 463) patients in ATHENA and 215/1237 (dronedarone = 148; placebo = 67) patients in EURIDIS/ADONIS studies had diabetes. In ATHENA, there were higher rates of CV hospitalization/death in patients with diabetes (39.5%) than without diabetes (34.7%). Incidence of first CV hospitalization/death was lower in patients with diabetes treated with dronedarone (35.1%) than placebo (44.1%), and time to this event was longer in those treated with dronedarone than placebo (log-rank p = 0.005). Median AF/AFL recurrence time was longer in patients treated with dronedarone than placebo in patients with diabetes (ATHENA: 722 vs 527 days, log-rank p = 0.004; EURIDIS/ADONIS: 100 vs 23 days, log-rank p = 0.15) or without diabetes (ATHENA: 741 vs 492 days, log-rank p < 0.0001; EURIDIS/ADONIS: 120 vs 59 days, log-rank p = 0.0002). Occurrence of any treatment-related adverse events with dronedarone was similar for patients with/without diabetes and was comparable to placebo. CONCLUSIONS Dronedarone reduced incidence of CV hospitalization/death, AF/AFL recurrence and increased time to these events in AF/AFL patients with/without diabetes. TRIAL REGISTRATION Not applicable, as it was a post hoc analysis. This article is based on previously conducted studies (ATHENA: NCT00174785, EURIDIS: NCT00259428, and ADONIS: NCT00259376).
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Affiliation(s)
- Yehuda Handelsman
- Metabolic Institute of America, Tarzana, CA, United States of America.
| | - T Jared Bunch
- School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, United States of America.
| | - Benjamin A Steinberg
- School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
| | - Munveer Thind
- Lankenau Heart Institute, Lankenau Medical Center, Wynnewood, PA, United States of America.
| | | | | | - Mattias Wieloch
- Sanofi, Paris, France; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Peter R Kowey
- Lankenau Heart Institute, Lankenau Medical Center, Wynnewood, PA, United States of America.
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Huang T, Wang W, Wang J, Lv J, Yu C, Guo Y, Pei P, Huang N, Yang L, Millwood IY, Walters RG, Chen Y, Du H, Su J, Chen J, Chen Z, Tang Y, Li L. Conventional and Bidirectional Genetic Evidence on Resting Heart Rate and Cardiometabolic Traits. J Clin Endocrinol Metab 2022; 107:e1518-e1527. [PMID: 34850013 DOI: 10.1210/clinem/dgab847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Observational studies have suggested that higher resting heart rate (RHR) may be associated with increased cardiometabolic risk. However, causal associations are not fully understood. OBJECTIVE We aimed to examine the direction, strength, and causality of the associations of RHR with cardiometabolic traits. METHODS We assessed the strength of associations between measured RHR and cardiometabolic traits in 506 211 and 372 452 participants from China Kadoorie Biobank (CKB) and UK Biobank (UKB). Mendelian randomization (MR) analyses were used to make causal inferences in 99 228 and 371 508 participants from CKB and UKB, respectively. RESULTS We identified significant directionally concordant observational associations between RHR and higher total cholesterol, triglycerides (TG), low-density lipoprotein, C-reactive protein (CRP), glucose, body mass index, waist-hip ratio (WHR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) after the Bonferroni correction. MR analyses showed that 10 beat/min higher genetically predicted RHR was trans-ethnically associated with a higher DBP (beta 2.059 [95% CI 1.544, 2.574] mmHg in CKB; 2.037 [1.845, 2.229] mmHg in UKB), higher CRP (0.180 [0.057, 0.303] log mg/L in CKB; 0.154 [0.134, 0.174] log mg/L in UKB), higher TG (0.052 [-0.009, 0.113] log mmol/L in CKB; 0.020 [0.010, 0.030] log mmol/L in UKB) and higher WHR (0.218 [-0.033, 0.469] % in CKB; 0.225 [0.111, 0.339] % in UKB). In the opposite direction, higher genetically predicted SBP, TG, glucose, and WHR, and lower high-density lipoprotein, were associated with elevated RHR. CONCLUSION Our large-scale analyses provide causal evidence for associations between RHR and cardiometabolic traits, highlighting the importance of monitoring heat rate as a means of alleviating the adverse effects of metabolic disorders.
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Affiliation(s)
- Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing 100191, China
| | - Wenxiu Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jingjia Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 102308, China
| | - Jun Lv
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Canqing Yu
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ninghao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Iona Y Millwood
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Robin G Walters
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit at the University of Oxford, Oxford OX3 7LF, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Jian Su
- Jiangsu CDC, Nanjing, Jiangsu 210009, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing 100022, China
| | - Zhengming Chen
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Yida Tang
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
| | - Liming Li
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
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3
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Tan J, Yang M, Wang H, Shen C, Wu M, Xu H, Wu Y, Li Y, Li X, Huang T, Deng S, Yang Z, Gao S, Li H, Zhou J, Chen H, Cao N, Cai W. Moderate heart rate reduction promotes cardiac regeneration through stimulation of the metabolic pattern switch. Cell Rep 2022; 38:110468. [PMID: 35263588 DOI: 10.1016/j.celrep.2022.110468] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/19/2021] [Accepted: 02/10/2022] [Indexed: 01/07/2023] Open
Abstract
As a biological pump, the heart needs to consume a substantial amount of energy to maintain sustained beating. Myocardial energy metabolism was recently reported to be related to the loss of proliferative capacity in cardiomyocytes (CMs). However, the intrinsic relationship between beating rate and proliferation in CMs and whether energy metabolism can regulate this relationship remains unclear. In this study, we find that moderate heart rate reduction (HRR) induces CM proliferation under physiological conditions and promotes cardiac regenerative repair after myocardial injury. Mechanistically, moderate HRR induces G1/S transition and increases the expression of glycolytic enzymes in CMs. Furthermore, moderate HRR induces a metabolic pattern switch, activating glucose metabolism and increasing the relative proportion of ATP production by the glycolytic pathway for biosynthesis of substrates needed for proliferative CMs. These results highlight the potential therapeutic role of HRR in not only acute myocardial protection but also long-term CM restoration.
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Affiliation(s)
- Jing Tan
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Ming Yang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Haiping Wang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Conghui Shen
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Maoxiong Wu
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - He Xu
- Program of Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong 510080, China
| | - Yandi Wu
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuanlong Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Xinghui Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Tongsheng Huang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Shijie Deng
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhenyu Yang
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Saifei Gao
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Hui Li
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Jiaguo Zhou
- Department of Pharmacology, Cardiac and Cerebrovascular Research Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangdong 510080, China
| | - Hui Chen
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
| | - Nan Cao
- Program of Stem Cells and Regenerative Medicine, Zhongshan School of Medicine, Sun Yat-Sen University, Guangdong 510080, China.
| | - Weibin Cai
- Laboratory Animal Center and Department of Biochemistry, Institute of Guangdong Engineering and Technology Research Center for Disease-Model Animals, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
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Sun N, Chen Y, Xi Y, Wang H, Wang L. Association Between Heart Rate and Major Adverse Cardiovascular Events Among 9,991 Hypertentive Patients: A Multicenter Retrospective Follow-Up Study. Front Cardiovasc Med 2021; 8:741784. [PMID: 34926603 PMCID: PMC8678089 DOI: 10.3389/fcvm.2021.741784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To assess the effect of heart rate at baseline on major adverse cardiovascular events (MACEs) among hypertensive patients in China. Methods: A multicenter retrospective study was conducted with a 24 month follow-up period. A total of 10,031 hypertensive patients treated with standard antihypertensive drugs were grouped according to their heart rate before treatment: <65 beats per min (bpm), 65-69 bpm, 70-74 bpm, 75-79 bpm, and ≥80 bpm. The occurrence of any of MACEs was as the endpoint event during the 24 month follow-up period. The effect of heart rate at baseline on MACEs was analyzed using univate and multivariable Cox proportional regression analyses, with hazard ratios (HRs) and 95% confidence intervals (CIs). The restricted cubic spline (RCS) model was used to fit the Cox proportional harzard model with 5 knots at the 5th, 25th, 50th, 75th, and 95th percentiles of heart rate. Results: Totally 9,991 patients were finally enrolled with the mean systolic pressure (SBP)/diastolic pressure (DBP) of 130.59 ± 7.13/77.66 ± 5.99 mmHg at 24 month follow-up. The incidence of MACEs was 4.80% (n = 480). After adjustment for age, gender, baseline blood pressure, alcohol drinking, smoking, hyperlipidemia, diabetes, coronary heart disease, cerebrovascular disease and antihypertensive drug use, patients with heart rate <65 bpm (HR = 1.450, 95% CI: 1.098-1.915) and ≥80 bpm (HR = 1.391, 95% CI: 1.056-11.832) showed 0.45 fold and 0.391 fold increases of MACE risks, compared with patients with heart rate of 70-74 bpm. Furthermore, MACE risks were increased by 86.0% and 65.4% in men, and 59.3% and 69.0% in elderly patients aged ≥65 years at heart rate <65 bpm or ≥80 bpm, respectively. We also found a non-liner U-shaped correlation between heart rate and the occurrence of MACEs. Conclusions: Heart rate might be an independent risk factor for MACEs in hypertensive patients. An appropriate range of heart rate control may offer guidance to hypertension treatment.
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Affiliation(s)
- Ningling Sun
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Chen
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Yang Xi
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Hongyi Wang
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
| | - Luyan Wang
- Department of Hypertension, Heart Center, Peking University People's Hospital, Beijing, China
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5
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Toreyhi H, Asgari S, Khalili D, Pishgahi M, Azizi F, Hadaegh F. Sudden cardiac death among Iranian population: a two decades follow-up of Tehran lipid and glucose study. Sci Rep 2021; 11:15720. [PMID: 34344986 PMCID: PMC8333266 DOI: 10.1038/s41598-021-95210-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
Sudden cardiac death (SCD) is described as death within one hour, if observed, from the onset of symptoms, and within 24 h of being alive and well if not observe. Study population includes 3705 men and 4446 women, aged ≥ 30 years. Multivariable Cox proportional hazard models were used to determine the risk factors associated with SCD. After a median follow-up of 17.9 years, 244 SCD (165 in males) occurred. The age-standardized incidence rate (95% confidence intervals (CI)) of SCD was 2.3 (2.1-2.7) per 1000 person-year. Current smoking [Hazard ratio (HR): 2.43, 95% CI: 1.73-3.42], high waist circumference [1.49: 1.04-2.12], hypertension [1.39: 1.05-1.84], type 2 diabetes mellitus [2.78: 2.09-3.69], pulse rate ≥ 90 beats per/minute [1.72: 1.22-2.42] and prevalent cardiovascular disease [1.75: 1.26-2.45] were significant risk factors. The corresponding population attributed fractions (PAF) were 14.30, 16.58, 14.03, 19.60, 7.62, and 8.30, respectively. Being overweight [0.58: 0.40-0.83] and obese [0.61: 0.38-0.98] decreased the risk of SCD. After excluding known diabetes cases from our data analysis, the newly diagnosed diabetes still showed an HR of 2.0 (1.32-3.00) with a PAF of 7.15% in the full adjustment model. To deal with sudden death as a catastrophic outcome, multi-component strategies by policy health makers are suggested.
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Affiliation(s)
- Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-4763, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-4763, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-4763, Tehran, Iran
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Pishgahi
- Interventional Cardiologist, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box, 19395-4763, Tehran, Iran.
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6
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Woodhams L, Sim TF, Chalmers L, Yeap B, Green D, Schlaich M, Schultz C, Hillis G. Diabetic kidney disease in type 2 diabetes: a review of pathogenic mechanisms, patient-related factors and therapeutic options. PeerJ 2021; 9:e11070. [PMID: 33976959 PMCID: PMC8061574 DOI: 10.7717/peerj.11070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
The global prevalence of diabetic kidney disease is rapidly accelerating due to an increasing number of people living with type 2 diabetes. It has become a significant global problem, increasing human and financial pressures on already overburdened healthcare systems. Interest in diabetic kidney disease has increased over the last decade and progress has been made in determining the pathogenic mechanisms and patient-related factors involved in the development and pathogenesis of this disease. A greater understanding of these factors will catalyse the development of novel treatments and influence current practice. This review summarises the latest evidence for the factors involved in the development and progression of diabetic kidney disease, which will inform better management strategies targeting such factors to improve therapeutic outcomes in patients living with diabetes.
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Affiliation(s)
- Louise Woodhams
- Curtin Medical School, Curtin University of Technology, Perth, Western Australia, Australia
| | - Tin Fei Sim
- Curtin Medical School, Curtin University of Technology, Perth, Western Australia, Australia
| | - Leanne Chalmers
- Curtin Medical School, Curtin University of Technology, Perth, Western Australia, Australia
| | - Bu Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel Green
- School of Human Sciences (Exercise and Sport Sciences), The University of Western Australia, Perth, Western Australia, Australia
| | - Markus Schlaich
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology and Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia.,Neurovascular Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit/Medical Research Foundation, The University of Western Australia, Perth, Western Australia, Australia
| | - Carl Schultz
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Graham Hillis
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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Gao J, Yuan G, Xu Z, Lan L, Xin W. Chenodeoxycholic and deoxycholic acids induced positive inotropic and negative chronotropic effects on rat heart. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2021; 394:765-773. [PMID: 32808070 DOI: 10.1007/s00210-020-01962-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/06/2020] [Indexed: 12/25/2022]
Abstract
Bile acids are endogenous amphiphilic steroids from the metabolites of cholesterol. Studies showed that they might contribute to the pathogenesis of cardiopathy in cholestatic liver diseases. Chenodeoxycholic acid (CDCA) and deoxycholic acid (DCA) is associated with colon cancer, gallstones, and gastrointestinal disorders. However, little information is available regarding their cardiac effects. Here, we reported that CDCA (100 μM) and DCA (100 μM) significantly increased the left ventricular developed pressure of the isolated rat hearts to 122.3 ± 5.6% and 145.1 ± 13.7%, and the maximal rate of the pressure development rising and descending (± dP/dtmax) to 103.4 ± 17.6% and 124.4 ± 37.7% of the basal levels, respectively. They decreased the heart rate and prolonged the RR, QRS, and QT intervals of Langendorff-perfused hearts in a concentration-dependent manner. Moreover, CDCA and DCA increased the developed tension of left ventricular muscle and the cytosolic Ca2+ concentrations in left ventricular myocytes; these functions positively coordinated with their inotropic effects on hearts. Additionally, CDCA (150 μM) and DCA (100 μM) decreased the sinoatrial node beating rate to 80.6 ± 3.0% and 79.7 ± 0.9% of the basal rate (334.2 ± 10.7 bpm), respectively. These results were consistent with their chronotropic effects. In conclusion, CDCA and DCA induced positive inotropic effects by elevating the Ca2+ in left ventricular myocytes. They exerted negative chronotropic effects by lowering the pace of the sinoatrial node in rat heart. These results indicated that the potential role of bile acids in cardiopathy related to cholestasis.
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Affiliation(s)
- Jie Gao
- College of Pharmaceutical Sciences and Chinese Medicine, Southwest University, 2 Tiansheng Road, Beibei, Chongqing, 400715, China
| | - Guanyin Yuan
- College of Pharmaceutical Sciences and Chinese Medicine, Southwest University, 2 Tiansheng Road, Beibei, Chongqing, 400715, China
| | - Zhan Xu
- College of Pharmaceutical Sciences and Chinese Medicine, Southwest University, 2 Tiansheng Road, Beibei, Chongqing, 400715, China
| | - Luyao Lan
- College of Pharmaceutical Sciences and Chinese Medicine, Southwest University, 2 Tiansheng Road, Beibei, Chongqing, 400715, China
| | - Wenkuan Xin
- College of Pharmaceutical Sciences and Chinese Medicine, Southwest University, 2 Tiansheng Road, Beibei, Chongqing, 400715, China.
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8
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Konecny T, Khoo M, Covassin N, Edelhofer P, Bukartyk J, Park JY, Venkataraman S, Karim S, Chahal A, Kara T, Orban M, Ludka O, Kautzner J, Ommen SR, Somers VK. Increased heart rate with sleep disordered breathing in hypertrophic cardiomyopathy. Int J Cardiol 2021; 323:155-160. [PMID: 32798627 PMCID: PMC10426808 DOI: 10.1016/j.ijcard.2020.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Current guidelines recommend medications with rate control properties for symptomatic patients with hypertrophic cardiomyopathy (HCM) based on the rationale that lowering heart rate (HR) improves their symptoms. Whether sleep disordered breathing (SDB) is associated with increased HR in HCM patients is not known. METHOD We diagnosed uncontrolled SDB (oxygen desaturation index ≥5) in consecutive echocardiographically confirmed HCM patients seen at Mayo Clinic, Rochester, and analyzed their HR as recorded by a 24-h Holter monitor. We compared mean, minimum, maximum HR between those with vs without SDB. In a pilot subanalysis of HCM patients with SDB who also underwent subsequent diagnostic polysomnography (PSG), we analyzed RR interval changes coinciding with obstructive sleep apnea and hypopnea episodes. RESULTS Of the 230 HCM patients included in this study (age 54 ± 16 years; 138 male; LVOT pressure gradient at rest 45 ± 39 mmHg), 115 (50%) patients had SDB. HCM patients with SDB were recorded to have higher mean HR (71 vs. 67 bpm; p = .002, adjusted p = .001), and this difference was most pronounced during night hours of 10 PM to 5 AM (61 vs. 67 bpm; p < .001). In the pilot analysis of the available PSG data, the release of obstructive sleep apneas and hypopneas coincided with fluctuation of HR. CONCLUSIONS SDB is independently associated with higher mean HR in patients with HCM, and this difference is most significant during sleep. Treatment of SDB, which is readily available, should be tested as a complementary modality to the currently recommended pharmacotherapy aimed at lowering HR in patients with symptomatic HCM.
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Affiliation(s)
- Tomas Konecny
- University of Southern California, Los Angeles, California, United States of America; Mayo Clinic, Rochester, MN, United States of America.
| | - Michael Khoo
- University of Southern California, Los Angeles, California, United States of America
| | | | | | - Jan Bukartyk
- Mayo Clinic, Rochester, MN, United States of America
| | - Jae Yoon Park
- Mayo Clinic, Rochester, MN, United States of America
| | | | - Shahid Karim
- Mayo Clinic, Rochester, MN, United States of America
| | - Anwar Chahal
- University of Southern California, Los Angeles, California, United States of America
| | - Tomas Kara
- Mayo Clinic, Rochester, MN, United States of America; Masaryk University Hospital, Brno, Czech Republic
| | - Marek Orban
- Comenius University and NUSCH, Bratislava, Slovakia
| | - Ondrej Ludka
- Mayo Clinic, Rochester, MN, United States of America; Masaryk University Hospital, Brno, Czech Republic
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Steve R Ommen
- Mayo Clinic, Rochester, MN, United States of America
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Barr JL, Lindenau KL, Brailoiu E, Brailoiu GC. Direct evidence of bradycardic effect of omega-3 fatty acids acting on nucleus ambiguus. Neurosci Lett 2020; 735:135196. [PMID: 32585256 DOI: 10.1016/j.neulet.2020.135196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/19/2020] [Indexed: 12/16/2022]
Abstract
Docosahexaenoic acid (DHA) an omega-3 polyunsaturated fatty acid, is an agonist of FFA1 receptor. DHA administration reduces the heart rate via unclear mechanisms. We examined the effect of DHA on neurons of nucleus ambiguus that provide the parasympathetic control of heart rate. DHA produced a dose-dependent increase in cytosolic Ca2+ concentration in cardiac-projecting nucleus ambiguus neurons; the effect was prevented by GW1100, a FFA1 receptor antagonist. DHA depolarized cultured nucleus ambiguus neurons via FFA1 activation. Bilateral microinjection of DHA into nucleus ambiguus produced bradycardia in conscious rats. Our results indicate that DHA decreases heart rate by activation of FFA1 receptor on cardiac-projecting nucleus ambiguus neurons.
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Affiliation(s)
- Jeffrey L Barr
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - Kristen L Lindenau
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut St, Suite 901, Philadelphia, PA 19107, United States
| | - Eugen Brailoiu
- Center for Substance Abuse Research, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, United States
| | - G Cristina Brailoiu
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, 901 Walnut St, Suite 901, Philadelphia, PA 19107, United States.
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10
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Raisi-Estabragh Z, Cooper J, Judge R, Khanji MY, Munroe PB, Cooper C, Harvey NC, Petersen SE. Age, sex and disease-specific associations between resting heart rate and cardiovascular mortality in the UK BIOBANK. PLoS One 2020; 15:e0233898. [PMID: 32470091 PMCID: PMC7259773 DOI: 10.1371/journal.pone.0233898] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To define the sex, age, and disease-specific associations of resting heart rate (RHR) with cardiovascular and mortality outcomes in 502,534 individuals from the UK Biobank over 7-12 years of prospective follow-up. METHODS The main outcomes were all-cause, cardiovascular, and ischaemic heart disease mortality. Additional outcomes included incident acute myocardial infarction (AMI), fatal AMI, and cancer mortality. We considered a wide range of confounders and the effects of competing hazards. Results are reported as hazard ratios (HR) for all-cause mortality and sub-distribution hazard ratios (SHR) for other outcomes with corresponding 95% confidence intervals (CI) per 10bpm increment of RHR. RESULTS In men, for every 10bpm increase of RHR there was 22% (HR 1.22, CI 1.20 to 1.24, p = 3×10-123) greater hazard of all-cause and 17% (SHR 1.17, CI 1.13 to 1.21, p = 5.6×10-18) greater hazard of cardiovascular mortality; for women, corresponding figures were 19% (HR 1.19, CI 1.16 to 1.22, p = 8.9×10-45) and 14% (SHR 1.14, CI 1.07 to 1.22, p = 0.00008). Associations between RHR and ischaemic outcomes were of greater magnitude amongst men than women, but with similar magnitude of association for non-cardiovascular cancer mortality [men (SHR 1.18, CI 1.15-1.21, p = 5.2×10-46); women 15% (SHR 1.15, CI 1.11-1.18, p = 3.1×10-18)]. Associations with all-cause, incident AMI, and cancer mortality were of greater magnitude at younger than older ages. CONCLUSIONS RHR is an independent predictor of mortality, with variation by sex, age, and disease. Ischaemic disease appeared a more important driver of this relationship in men, and associations were more pronounced at younger ages.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Rebekah Judge
- Imperial College Healthcare Trust, St Mary’s Hospital, London, United Kingdom
| | - Mohammed Y. Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Patricia B. Munroe
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit (MRCLEU), Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit (MRCLEU), Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Steffen E. Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
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11
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Md Lazin Md Lazim MR, Aminuddin A, Chellappan K, Ugusman A, Hamid AA, Wan Ahmad WAN, Mohamad MSF. Is Heart Rate a Confounding Factor for Photoplethysmography Markers? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072591. [PMID: 32290168 PMCID: PMC7177218 DOI: 10.3390/ijerph17072591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/18/2022]
Abstract
Finger photoplethysmography (PPG) waveform is blood volume change of finger microcirculation that reflects vascular function. Reflection index (RI), stiffness index (SI) and second derivative of photoplethysmogram (SDPPG) are derived from PPG waveforms proposed as cardiovascular disease (CVD) markers. Heart rate (HR) is a known factor that affects vascular function. Individual resting HR variation may affect RI, SI and SDPPG. This review aims to identify studies about the relationship between HR with RI, SI and SDPPG among humans. A literature search was conducted in Medline via the Ebscohost and Scopus databases to find relevant articles published within 11 years. The main inclusion criteria were articles in the English language that discuss the relationship between HR with RI, SI and SDPPG using PPG among humans. The search found 1960 relevant articles but only six articles that met the inclusion criteria. SI and RI showed an association with HR. SDPPG (SDPPG-b/SDPPG-a ratio, SDPPG-d/SDPPG-a ratio, aging index (AGI) and revised aging index (RAGI)) also had an association with HR. Only RI had a considerable association with HR, the association between SI and HR was non-considerable and the association between HR and SDPPG was inconclusive. Further interventional studies should be conducted to investigate this issue, as a variation in resting HR may challenge the validity of PPG-based CVD markers.
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Affiliation(s)
- Md Rizman Md Lazin Md Lazim
- Department of Physiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Amilia Aminuddin
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Kalaivani Chellappan
- Centre of Advance Electronic & Communication Engineering (PAKET), Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia
- Correspondence: ; Tel.: +603-8911-8374
| | - Azizah Ugusman
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Adila A Hamid
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia; (A.A.); (A.U.); (A.A.H.)
| | - Wan Amir Nizam Wan Ahmad
- Biomedicine Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Mohd Shawal Faizal Mohamad
- Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Cheras 56000, Kuala Lumpur, Malaysia;
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12
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Risk Factor Variability and Cardiovascular Outcome: JACC Review Topic of the Week. J Am Coll Cardiol 2020; 73:2596-2603. [PMID: 31118154 DOI: 10.1016/j.jacc.2019.02.063] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 02/08/2023]
Abstract
Until recently, intraindividual visit-to-visit variability of cardiovascular risk factors has been dismissed as random fluctuation. This simplistic concept was challenged by demonstrating that visit-to-visit blood pressure variability, independent of average blood pressure, was a powerful risk factor for stroke. Subsequently, variability of other cardiovascular risk factors such as cholesterol, glycemia, and body weight was documented to increase risk independent of their absolute values. Variability of these risk factors has been demonstrated to be a powerful predictor for all-cause and cardiovascular mortality, stroke, coronary artery disease, heart failure, end-stage renal disease, and dementia. With the notable exception of heart rate, cardiovascular risk factors must now be defined by 2 components: the magnitude and duration of sustained risk factor elevation and, equally important, the variability of the same risk factor over time.
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Tian J, Yuan Y, Shen M, Zhang X, He M, Guo H, Yang H, Wu T. Association of resting heart rate and its change with incident cardiovascular events in the middle-aged and older Chinese. Sci Rep 2019; 9:6556. [PMID: 31024039 PMCID: PMC6484081 DOI: 10.1038/s41598-019-43045-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 04/02/2019] [Indexed: 01/15/2023] Open
Abstract
Whether heart rate change is associated with cardiovascular disease (CVD) in the general population is unclear. We conducted a prospective cohort study to assess the association of resting heart rate and its change with incident CVD in the middle-aged and older Chinese. Resting heart rate was measured during the baseline survey (September 2008 to June 2010) and the resurvey (2013). Incident CVD was followed up until December 31, 2016. Finally, a total of 20,828 participants were included in the analyses of baseline heart rate and 9132 participants were included in the analyses of heart rate change. The associations of baseline heart rate and heart rate change with incident CVD were assessed with multivariable Cox proportional hazards models. Compared with moderate baseline heart rate (65 to 80 bpm), low baseline heart rate (<65 bpm) was associated with higher risk of CVD (HR, 1.19; 95% CI, 1.07–1.32). Compared with stable heart rate (−5 to 15 bpm) in the moderate baseline heart rate group (65 to 80 bpm), an increase of heart rate (>15 bpm) in high baseline heart rate group (>80 bpm) (HR, 1.67; 95% CI, 1.02–2.71) or a decrease of heart rate (<−5 bpm) in low baseline heart rate group (<65 bpm) (HR, 2.48; 95% CI, 1.27–4.82) was associated with higher risk of CVD. In conclusion, low resting heart rate is associated with higher risk of CVD. Both continuous increase in high baseline heart rate and decrease in low baseline heart rate are associated with higher risk of CVD.
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Affiliation(s)
- Jing Tian
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Yuan
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Miaoyan Shen
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaomin Zhang
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meian He
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Guo
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Handong Yang
- Dongfeng Central Hospital, Dongfeng Motor Corporation and Hubei University of Medicine, Shiyan, Hubei, China
| | - Tangchun Wu
- Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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14
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Chen XJ, Barywani SB, Hansson PO, Östgärd Thunström E, Rosengren A, Ergatoudes C, Mandalenakis Z, Caidahl K, Fu ML. Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population. Open Heart 2019; 6:e000856. [PMID: 31168369 PMCID: PMC6519434 DOI: 10.1136/openhrt-2018-000856] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/02/2018] [Accepted: 01/20/2019] [Indexed: 02/05/2023] Open
Abstract
Background Resting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events. Design A random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period. Methods Participants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm). Results Participants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD. Conclusion High RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.
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Affiliation(s)
- Xiao-Jing Chen
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Cardiology, Sichuan University West China Hospital, Chengdu, China
| | - Salim Bary Barywani
- Department of Cardiology, Sahlgrenska Academy. University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine/ Emergency and Cardiovascular Medicine Cardiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Erik Östgärd Thunström
- Department of Cardiology, Sahlgrenska Academy. University of Gothenburg, Gothenburg, Sweden
| | | | | | - Zacharias Mandalenakis
- Molecular and Clinical Medicine, Goteborgs universitet Sahlgrenska Akademin, Goteborg, Sweden
| | - Kenneth Caidahl
- Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Lx Fu
- Department of Cardiology, Sahlgrenska Academy. University of Gothenburg, Gothenburg, Sweden
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15
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Fu D, Wu C, Li X, Chen J. Elevated preoperative heart rate associated with increased risk of cardiopulmonary complications after resection for lung cancer. BMC Anesthesiol 2018; 18:94. [PMID: 30045695 PMCID: PMC6060559 DOI: 10.1186/s12871-018-0558-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The study aimed to assess whether preoperative resting heart rate could be a risk factor for cardiopulmonary complications (CPCs) after lung cancer resection. METHODS Eligible consecutive patients who underwent resection surgery for non-small cell lung cancer (NSCLC) at Ningbo NO.2 Hospital between May, 2010 and July, 2015 were included. The demographic, clinical characteristics and laboratory parameters were compared in patients with or without CPCs within postoperative 30 days. The multivariate logistic regression analysis was used to analyze the association between CPCs and risk factors. Receiver operating characteristic (ROC) curve analysis was utilized for the predictive role of preoperative resting heart rate for CPCs. RESULTS One hundred eighty participants were enrolled into the final analysis and 42 of them had an established diagnosis of CPCs within postoperative 30 days. Elevated preoperative resting heart rate was an independent risk factor for postoperative CPCs (OR: 4.48, 95% CI: 1.17-18.42, P = 0.021) by the multivariate logistic regression analysis. ROC curve analysis indicated elevated resting heart rate as a predictor for CPCs with a cut-off value of 86 beats/min (AUC: 0.813, specificity: 80.95%, sensitivity: 72.46%, P < 0.001). CONCLUSIONS Elevated preoperative resting heart rate was associated with an increased risk of postoperative CPCs in patients after resection for lung cancer.
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Affiliation(s)
- Danxia Fu
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Chaoshuang Wu
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Xiaoyu Li
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
| | - Junping Chen
- Department of anesthesiology, Ningbo NO.2 hospital, NO.41 Xibei Street, Ningbo City, 315000 Zhejiang Province China
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16
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Sharashova E, Wilsgaard T, Løchen ML, Mathiesen EB, Njølstad I, Brenn T. Resting heart rate trajectories and myocardial infarction, atrial fibrillation, ischaemic stroke and death in the general population: The Tromsø Study. Eur J Prev Cardiol 2017; 24:748-759. [DOI: 10.1177/2047487316688983] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Norway
| | - Ellisiv B Mathiesen
- Department of Community Medicine, UiT The Arctic University of Norway, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Norway
| | - Tormod Brenn
- Department of Community Medicine, UiT The Arctic University of Norway, Norway
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17
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Zhang D, Wang W, Li F. Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis. CMAJ 2016; 188:E384-E392. [PMID: 27551034 DOI: 10.1503/cmaj.160050] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Resting heart rate is linked to risk of coronary artery disease, stroke, sudden death and noncardiovascular diseases. We conducted a meta-analysis to assess these associations in general populations and in populations of patients with hypertension or diabetes mellitus. METHODS We searched PubMed, Embase and MEDLINE from inception to Mar. 5, 2016. We used a random-effects model to combine study-specific relative risks (RRs). We used restricted cubic splines to assess the dose-response relation. RESULTS We included 45 nonrandomized prospective cohort studies in the meta-analysis. The multivariable adjusted RR with an increment of 10 beats/min in resting heart rate was 1.12 (95% confidence interval [CI] 1.09-1.14) for coronary artery disease, 1.05 (95% CI 1.01-1.08) for stroke, 1.12 (95% CI 1.02-1.24) for sudden death, 1.16 (95% CI 1.12-1.21) for noncardiovascular diseases, 1.09 (95% CI 1.06-1.12) for all types of cancer and 1.25 (95% CI 1.17-1.34) for noncardiovascular diseases excluding cancer. All of these relations were linear. In an analysis by category of resting heart rate (< 60 [reference], 60-70, 70-80 and > 80 beats/min), the RRs were 0.99 (95% CI 0.93-1.04), 1.08 (95% CI 1.01-1.16) and 1.30 (95% CI 1.19-1.43), respectively, for coronary artery disease; 1.08 (95% CI 0.98-1.19), 1.11 (95% CI 0.98-1.25) and 1.08 (95% CI 0.93-1.25), respectively, for stroke; and 1.17 (95% CI 0.94-1.46), 1.31 (95% CI 1.12-1.54) and 1.57 (95% CI 1.39-1.77), respectively, for noncardiovascular diseases. After excluding studies involving patients with hypertension or diabetes, we obtained similar results for coronary artery disease, stroke and noncardiovascular diseases, but found no association with sudden death. INTERPRETATION Resting heart rate was an independent predictor of coronary artery disease, stroke, sudden death and noncardiovascular diseases over all of the studies combined. When the analysis included only studies concerning general populations, resting heart rate was not associated with sudden death.
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Affiliation(s)
- Dongfeng Zhang
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
| | - Weijing Wang
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
| | - Fang Li
- Department of Epidemiology and Health Statistics, Medical College of Qingdao University, Shandong, Qingdao, China
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Bartáková V, Klimešová L, Kianičková K, Dvořáková V, Malúšková D, Řehořová J, Svojanovský J, Olšovský J, Bělobrádková J, Kaňková K. Resting Heart Rate Does Not Predict Cardiovascular and Renal Outcomes in Type 2 Diabetic Patients. J Diabetes Res 2016; 2016:6726492. [PMID: 26824046 PMCID: PMC4707347 DOI: 10.1155/2016/6726492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/13/2015] [Accepted: 11/24/2015] [Indexed: 12/19/2022] Open
Abstract
Elevated resting heart rate (RHR) has been associated with increased risk of mortality and cardiovascular events. Limited data are available so far in type 2 diabetic (T2DM) subjects with no study focusing on progressive renal decline specifically. Aims of our study were to verify RHR as a simple and reliable predictor of adverse disease outcomes in T2DM patients. A total of 421 T2DM patients with variable baseline stage of diabetic kidney disease (DKD) were prospectively followed. A history of the cardiovascular disease was present in 81 (19.2%) patients at baseline, and DKD (glomerular filtration rate < 60 mL/min or proteinuria) was present in 328 (77.9%) at baseline. Progressive renal decline was defined as a continuous rate of glomerular filtration rate loss ≥ 3.3% per year. Resting heart rate was not significantly higher in subjects with cardiovascular disease or DKD at baseline compared to those without. Using time-to-event analyses, significant differences in the cumulative incidence of the studied outcomes, that is, progression of DKD (and specifically progressive renal decline), major advanced cardiovascular event, and all-cause mortality, between RHR </≥65 (arbitrary cut-off) and 75 (median) bpm were not found. We did not ascertain predictive value of the RHR for the renal or cardiovascular outcomes in T2DM subjects in Czech Republic.
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Affiliation(s)
- Vendula Bartáková
- Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Kamenice 5, 62500 Brno, Czech Republic
- *Vendula Bartáková:
| | - Linda Klimešová
- Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Kamenice 5, 62500 Brno, Czech Republic
| | - Katarína Kianičková
- Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Kamenice 5, 62500 Brno, Czech Republic
| | - Veronika Dvořáková
- Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Kamenice 5, 62500 Brno, Czech Republic
| | - Denisa Malúšková
- Institute of Biostatistics and Analyses, Masaryk University Brno, Kamenice 126/3, 62500 Brno, Czech Republic
| | - Jitka Řehořová
- Department of Internal Medicine-Gastroenterology, University Hospital Brno, Jihlavská 20, 62500 Brno, Czech Republic
| | - Jan Svojanovský
- 2nd Department of Internal Medicine, St. Anne's University Hospital, Pekařská 53, 65691 Brno, Czech Republic
| | - Jindřich Olšovský
- 2nd Department of Internal Medicine, St. Anne's University Hospital, Pekařská 53, 65691 Brno, Czech Republic
| | - Jana Bělobrádková
- Department of Internal Medicine-Gastroenterology, University Hospital Brno, Jihlavská 20, 62500 Brno, Czech Republic
| | - Kateřina Kaňková
- Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Kamenice 5, 62500 Brno, Czech Republic
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Hove KD, Brøns C, Færch K, Lund SS, Rossing P, Vaag A. Effects of 12 weeks of treatment with fermented milk on blood pressure, glucose metabolism and markers of cardiovascular risk in patients with type 2 diabetes: a randomised double-blind placebo-controlled study. Eur J Endocrinol 2015; 172:11-20. [PMID: 25300285 DOI: 10.1530/eje-14-0554] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Studies have indicated a blood pressure (BP)-lowering effect of milk-derived peptides in non-diabetic individuals, but the cardiometabolic effects of such peptides in patients with type 2 diabetes (T2D) are not known. We investigated the effect of milk fermented with Lactobacillus helveticus on BP, glycaemic control and cardiovascular risk factors in T2D. DESIGN A randomised, double-blinded, prospective, placebo-controlled study. METHODS In one arm of a factorial study design, 41 patients with T2D were randomised to receive 300 ml milk fermented with L. helveticus (Cardi04 yogurt) (n=23) or 300 ml artificially acidified milk (placebo yogurt) (n=18) for 12 weeks. BPs were measured over 24-h, and blood samples were collected in the fasting state and during a meal test before and after the intervention. RESULTS Cardi04 yogurt did not reduce 24-h, daytime or nighttime systolic or diastolic BPs compared with placebo (P>0.05). Daytime and 24-h heart rate (HR) were significantly reduced in the group treated by Cardi04 yogurt compared with the placebo group (P<0.05 for both). There were no differences in HbA1c, plasma lipids, C-reactive protein, plasminogen activator inhibitor-1, tumour necrosis factor alpha, tissue-type plasminogen activator: Ag, and von Willebrand factor: Ag between the groups. The change in fasting blood glucose concentration differed significantly between the two groups with a larger increase in the placebo group (P<0.05). CONCLUSIONS Ingestion of milk fermented with L. helveticus compared with placebo for 12 weeks did not significantly reduce BP in patients with T2D. Our finding of lower HRs and fasting plasma glucose levels in T2D patients during ingestion of fermented milk needs further validation.
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Affiliation(s)
- K D Hove
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - C Brøns
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - K Færch
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - S S Lund
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - P Rossing
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Vaag
- Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark Steno Diabetes Center A/SNiels Steensens Vej 2, DK-2820 Gentofte, DenmarkHealthUniversity of Aarhus, Aarhus, DenmarkNNF Center for Basic Metabolic ResearchDepartment of EndocrinologyDiabetes and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Makita S, Onoda T, Ohsawa M, Tanno K, Tanaka F, Omama S, Yoshida Y, Ishibashi Y, Itai K, Sakata K, Ohta M, Kuribayashi T, Ogasawara K, Ogawa A, Okayama A, Nakamura M. Bradycardia is associated with future cardiovascular diseases and death in men from the general population. Atherosclerosis 2014; 236:116-20. [PMID: 25020106 DOI: 10.1016/j.atherosclerosis.2014.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although a higher heart rate is known to be a risk factor for cardiovascular disease (CVD) events, there have been no reports concerning bradycardia. Whether lower and higher resting pulse rates (RPRs) are associated with cardiovascular risk was investigated in subjects from a community-based, prospective cohort study. METHODS After subjects with atrial fibrillation, subjects with a history of CVD, and subjects receiving antihypertensive treatment were excluded, 17,766 subjects (5958 men), aged 40-79 (mean 61.5) years, were analyzed. The RPR at baseline was categorized into four groups (RPR<60, 60-69.5, 70-79.5, ≥80 beats per minute (bpm)) using the average value of two consecutive measurements. The endpoint was set as the composite outcome of myocardial infarction, stroke, or sudden death. RESULTS During a mean follow-up of 5.6 years, there were 213 events in men and 186 events in women. In Cox regression models, increased risks of CVD were found in the men group with RPR<60 bpm, as well as the group with RPR≥80 bpm, compared with the reference group with RPR 60-69.5 bpm (hazard ratio [HR] = 1.73, p = 0.005 and HR = 2.01, p < 0.001). These increased risks were found even when adjusted for age and other CVD risk factors (HR = 1.55, p = 0.026 with RPR<60 bpm and HR = 1.72, p = 0.009 with RPR≥80 bpm). In women, there were no significant associations between RPR and CVD risk. CONCLUSION Bradycardia, as well as a higher pulse rate, may be an independent risk factor for future cardiovascular events in apparently healthy men.
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Affiliation(s)
- Shinji Makita
- Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
| | - Toshiyuki Onoda
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Masaki Ohsawa
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Fumitaka Tanaka
- Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Shinichi Omama
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Yuki Yoshida
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | | | - Kazuyoshi Itai
- Department of Nutritional Sciences, Morioka University, Japan
| | - Kiyomi Sakata
- Department of Hygiene and Preventive Medicine, Iwate Medical University, Morioka, Japan
| | - Mutsuko Ohta
- Iwate Health Service Association, Morioka, Japan
| | - Toru Kuribayashi
- Department of Health and Physical Education, Faculty of Education, Iwate University, Morioka, Japan
| | - Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Akira Ogawa
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan
| | - Akira Okayama
- First Institute of Health Service, Japan Anti-Tuberculosis Association, Tokyo, Japan
| | - Motoyuki Nakamura
- Division of Cardioangiology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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Ushigome E, Fukui M, Hamaguchi M, Tanaka T, Atsuta H, Ohnishi M, Tsunoda S, Yamazaki M, Hasegawa G, Nakamura N. Home-measured heart rate is associated with albuminuria in patients with type 2 diabetes mellitus: a post-hoc analysis of a cross-sectional multicenter study. Hypertens Res 2014; 37:533-7. [DOI: 10.1038/hr.2014.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/07/2013] [Accepted: 09/18/2013] [Indexed: 11/09/2022]
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Hisamatsu T, Miura K, Ohkubo T, Yamamoto T, Fujiyoshi A, Miyagawa N, Kadota A, Takashima N, Okuda N, Yoshita K, Kita Y, Murakami Y, Nakamura Y, Okamura T, Horie M, Okayama A, Ueshima H. High long-chain n-3 fatty acid intake attenuates the effect of high resting heart rate on cardiovascular mortality risk: a 24-year follow-up of Japanese general population. J Cardiol 2014; 64:218-24. [PMID: 24529505 DOI: 10.1016/j.jjcc.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/24/2013] [Accepted: 01/06/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increased resting heart rate (RHR) independently predicts cardiovascular mortality. Meanwhile, long-chain n-3 fatty acids (LCn3FAs) have a cardioprotective effect. Our aim was to evaluate whether higher LCn3FAs intake attenuates the elevated risk of cardiovascular mortality associated with increased RHR. METHODS We conducted a population-based 24-year prospective cohort study of Japanese, whose LCn3FAs intake is relatively high. Study participants included 8807 individuals aged 30-95 years from randomly selected areas across Japan without cardiovascular diseases and anti-hypertensive drugs at baseline. The primary endpoint was cardiovascular mortality, and the secondary endpoints were cardiac and stroke mortality during 24 years of follow-up. Individual dietary LCn3FAs intake was estimated from household-based 3-day weighed food records. RHR was obtained from 3 consecutive R-wave intervals on 12-lead electrocardiography. Cox models were used to estimate the multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) adjusting for possible confounders. RESULTS During the follow-up period, 617 cardiovascular deaths were observed. The median daily intake of LCn3FAs was 0.37% kcal (0.86g/day). The interaction between dietary LCn3FAs intake and RHR in the risk of cardiovascular mortality was statistically significant (p=0.033). The risk of cardiovascular mortality was significantly higher in the low-intake group (<0.37%kcal) with an RHR >85beats/min (bpm) [hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.15-2.43], but not in the high-intake group (≥0.37%kcal) with an RHR >85bpm (HR, 0.92; 95% CI, 0.61-1.38), compared with those in the high-intake group with an RHR <70bpm. Similar results were observed with stroke mortality, but not with cardiac mortality. CONCLUSIONS The risk of cardiovascular mortality associated with increased RHR is elevated in participants with low dietary LCn3FAs intake, but not in participants with high dietary LCn3FAs intake in a representative Japanese general population. These results suggest that high dietary LCn3FAs intake may prevent cardiovascular mortality associated with increased RHR.
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Affiliation(s)
- Takashi Hisamatsu
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan; Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan.
| | - Katsuyuki Miura
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - Takayoshi Ohkubo
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan; Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Yamamoto
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Akira Fujiyoshi
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - Naoko Miyagawa
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - Aya Kadota
- Department of School Nursing and Health Education, Osaka Kyoiku University, Osaka, Japan
| | - Naoyuki Takashima
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - Nagako Okuda
- Section of Shokuiku, Department of Nutritional Education, National Institute of Health and Nutrition, Tokyo, Japan
| | - Katsushi Yoshita
- Department of Food Science and Nutrition, Osaka City University, Osaka, Japan
| | - Yoshikuni Kita
- Department of Health Science, Shiga University of Medical Science, Otsu, Japan
| | - Yoshitaka Murakami
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan
| | | | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Akira Okayama
- First Institute for Health Promotion and Health Care, Tokyo, Japan
| | - Hirotsugu Ueshima
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan; Department of Health Science, Shiga University of Medical Science, Otsu, Japan
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Heart rate as a possible therapeutic guide for the prevention of cardiovascular disease. Hypertens Res 2013; 36:838-44. [PMID: 23966053 DOI: 10.1038/hr.2013.98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/03/2013] [Accepted: 04/18/2013] [Indexed: 11/08/2022]
Abstract
Epidemiologic evidence indicates that an elevated heart rate (HR) is an independent predictor of all-cause and cardiovascular (CV) mortality. Ivabradine, a pure HR-lowering agent, reduces CV events in patients with coronary artery disease (CAD) and chronic heart failure, and indicate that an HR greater than 70 b.p.m. is hazardous. These findings demonstrate not only that an elevated HR is an epiphenomenon of CV risk status but also that an elevated HR itself should be a therapeutic target. In addition, recent epidemiologic evidence demonstrates that the in-treatment HR or HR change predicts subsequent all-cause and CV mortality, independent of the HR-lowering strategy. Characteristics of the in-treatment HR or HR change are also important as possible therapeutic guides for risk management. However, there have been concerns regarding deleterious effects on CV event prevention owing to β-blocker-derived pharmacologic HR reduction. The potential role of HR and its modulation should be considered in future guidance documents.
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24
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[Resting heart rate and cardiovascular disease]. Med Clin (Barc) 2013; 143:34-8. [PMID: 23937816 DOI: 10.1016/j.medcli.2013.05.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/28/2013] [Accepted: 05/30/2013] [Indexed: 01/29/2023]
Abstract
Heart rate reflects autonomic nervous system activity. Numerous studies have demonstrated that an increased heart rate at rest is associated with cardiovascular morbidity and mortality as an independent risk factor. It has been shown a link between cardiac autonomic balance and inflammation. Thus, an elevated heart rate produces a micro-inflammatory response and is involved in the pathogenesis of endothelial dysfunction. In turn, decrease in heart rate produces benefits in congestive heart failure, myocardial infarction, atrial fibrillation, obesity, hyperinsulinemia, insulin resistance, and atherosclerosis. Alteration of other heart rate-related parameters, such as their variability and recovery after exercise, is associated with risk of cardiovascular events. Drugs reducing the heart rate (beta-blockers, calcium antagonists and inhibitors of If channels) have the potential to reduce cardiovascular events. Although not recommended in healthy subjects, interventions for reducing heart rate constitute a reasonable therapeutic goal in certain pathologies.
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Bertini P, Ferro B, Baldassarri R, Genovesi F, Guarracino F. Beta-Adrenergic Antagonists Improve Oxygen Saturation in Acute Pulmonary Edema: A Case Series in the Prehospital Setting. PREHOSP EMERG CARE 2013; 17:421-3. [DOI: 10.3109/10903127.2013.785621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pietro Bertini
- From the Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa (PB, BF, RB, FG),
Pisa, Italy; and the Department of Emergency Medicine, Livorno Community Hospital (FG),
Livorno, Italy
| | - Baldassarre Ferro
- From the Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa (PB, BF, RB, FG),
Pisa, Italy; and the Department of Emergency Medicine, Livorno Community Hospital (FG),
Livorno, Italy
| | - Rubia Baldassarri
- From the Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa (PB, BF, RB, FG),
Pisa, Italy; and the Department of Emergency Medicine, Livorno Community Hospital (FG),
Livorno, Italy
| | - Francesco Genovesi
- From the Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa (PB, BF, RB, FG),
Pisa, Italy; and the Department of Emergency Medicine, Livorno Community Hospital (FG),
Livorno, Italy
| | - Fabio Guarracino
- From the Department of Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa (PB, BF, RB, FG),
Pisa, Italy; and the Department of Emergency Medicine, Livorno Community Hospital (FG),
Livorno, Italy
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Improved Hypertension Control with the Imidazoline Agonist Moxonidine in a Multinational Metabolic Syndrome Population: Principal Results of the MERSY Study. Int J Hypertens 2013; 2013:541689. [PMID: 23533713 PMCID: PMC3596898 DOI: 10.1155/2013/541689] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 01/12/2013] [Indexed: 12/23/2022] Open
Abstract
This study was designed to assess the effects of moxonidine on blood pressure and aspects of the metabolic syndrome in racially diverse population of patients encountered in routine medical practice. Physicians collected data on a minimum of three consecutive patients with uncontrolled essential hypertension and criteria for metabolic syndrome, eligible to receive moxonidine (0.2-0.4 mg once daily) for 6 months, either as monotherapy or as adjunct therapy to current antihypertensive treatment. Systolic and diastolic blood pressure (BP) declined by an average of 24.5 + 14.3 mmHg and 12.6 + 9.1 mmHg, respectively. BP responder rates defined as attaining BP < 140/90 mmHg were significantly (P < 0.001) and substantially higher among younger patients, nonpostmenopausal women, and patients receiving monotherapy. While potentially relevant improvements in the entire cohort were observed in regard to body weight (-2.1 ± 5.4 kg), fasting plasma glucose (from 6.8 to 6.2 mmol/L), and triglycerides (2.4 to 2.0 mmol/L), statistically significant changes in metabolic parameters could only be detected in subgroup analyses. Moxonidine therapy reduced blood pressure and improved rates of blood pressure control in this group of patients. While the observed trend towards improvement in various metabolic parameters merits further investigation, the overall effect of moxonidine treatment is consistent with a reduction of total cardiovascular risk in this hypertensive metabolic syndrome cohort.
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Salles GF, Cardoso CRL, Fonseca LL, Fiszman R, Muxfeldt ES. Prognostic significance of baseline heart rate and its interaction with beta-blocker use in resistant hypertension: a cohort study. Am J Hypertens 2013; 26:218-26. [PMID: 23382406 DOI: 10.1093/ajh/hps004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prognostic significance of heart rate (HR) and its relationship with beta-blocker use are controversial and have never been evaluated in resistant hypertension. METHODS In a prospective study, 528 patients with resistant hypertension had HR measured on clinical examination, electrocardiography (ECG), and during ambulatory blood pressure monitoring. Primary endpoints were a composite of fatal and nonfatal cardiovascular events, all-cause and cardiovascular mortality. Multivariable Cox regression was used to assess the associations between slow HR (< 60 bpm or < 55 bpm for nighttime HR) and fast HR (> 75 bpm or > 70 bpm for nighttime HR) and the occurrence of endpoints in relation to the reference middle HR (60-75 bpm) subgroup. RESULTS After a median follow-up of 4.8 years, 62 patients died, 44 from cardiovascular causes; and 94 cardiovascular events occurred. Fast and slow HRs were mainly predictors of mortality, and ambulatory HRs were more significant risk markers than clinic or ECG HR. A slow 24-hour HR was a predictor of the composite endpoint (hazard ratio, 2.0; 95% confidence interval [CI], 1.2-3.4), whereas both slow and fast ambulatory HRs were predictors of cardiovascular mortality (hazard ratio, 2.3; 95% CI, 1.1-5.1). Four hundred and seventeen patients (79%) were using beta-blockers and this affected the HR prognostic value. A fast HR was a more significant risk marker in patients using beta-blockers, whereas a slow HR was a predictor mainly in those not using beta-blockers. CONCLUSIONS There is an overall U-shaped relationship between HRs, particularly when measured during ambulatory monitoring, and prognosis in resistant hypertension. A fast HR is a significant predictor in patients using beta-blockers, while a slow heart rate is a more important predictor in those not using beta-blockers.
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Affiliation(s)
- Gil F Salles
- Department of Internal Medicine, University Hospital Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
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N. Orekhov A. Direct anti-atherosclerotic therapy preventing intracellular cholesterol retention. Health (London) 2013. [DOI: 10.4236/health.2013.57a1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cheng S, Xanthakis V, Sullivan LM, Vasan RS. Blood pressure tracking over the adult life course: patterns and correlates in the Framingham heart study. Hypertension 2012; 60:1393-9. [PMID: 23108660 DOI: 10.1161/hypertensionaha.112.201780] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The extent to which select vascular risk factors differentially influence blood pressure (BP) is incompletely understood. Thus, we used multilevel modeling to analyze serial BP measurements using 21 732 person-observations obtained on Framingham Heart Study participants (mean age, 38 years, 52% women; 4993 unique individuals) over a 28-year period. We related longitudinal tracking of each BP measure (systolic BP, diastolic BP, mean arterial pressure, and pulse pressure) to age, sex, body mass index, smoking, diabetes mellitus, total/high-density lipoprotein cholesterol ratio, and heart rate. In multivariable-adjusted analyses, we observed that older age, male sex, greater body mass index, and higher heart rate were positively associated with increase in all BP measures (P<0.0001). Notably, higher total/high-density lipoprotein cholesterol ratio was associated with greater mean arterial pressure (P<0.01). Conversely, diabetes mellitus and smoking were associated with higher pulse pressure (P<0.01). We also observed effect modification by sex: the increase in pulse pressure with age and body mass index was more pronounced in women compared with men (P<0.0001). All BP measures tracked at higher levels in both men and women with multiple vascular risk factors. Taken together, our longitudinal observations in a large community-based sample demonstrate a greater pulsatile load in women than in men with increasing age. We also observed a differential impact of select vascular risk factors on the individual components of BP, underscoring distinct regulation of these measures over the life course.
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Affiliation(s)
- Susan Cheng
- Framingham Heart Study, Framingham, MA, USA.
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Hillis GS, Hata J, Woodward M, Perkovic V, Arima H, Chow CK, Zoungas S, Patel A, Poulter NR, Mancia G, Williams B, Chalmers J. Resting heart rate and the risk of microvascular complications in patients with type 2 diabetes mellitus. J Am Heart Assoc 2012; 1:e002832. [PMID: 23316296 PMCID: PMC3541618 DOI: 10.1161/jaha.112.002832] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 07/27/2012] [Indexed: 12/17/2022]
Abstract
Background A higher resting heart rate is associated with an increased probability of cardiovascular complications and premature death in patients with type 2 diabetes mellitus. The impact of heart rate on the risk of developing microvascular complications, such as diabetic retinopathy and nephropathy, is, however, unknown. The present study tests the hypothesis that a higher resting heart rate is associated with an increased incidence and a greater progression of microvascular complications in patients with type 2 diabetes mellitus. Methods and Results The relation between baseline resting heart rate and the development of a major microvascular event was examined in 11 140 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) study. Major microvascular events were defined as a composite of new or worsening nephropathy or new or worsening retinopathy. Patients with a higher baseline heart rate were at increased risk of a new major microvascular complication during follow-up (adjusted hazard ratio: 1.13 per 10 beats per minute; 95% confidence interval: 1.07–1.20; P<0.001). The excess hazard was evident for both nephropathy (adjusted hazard ratio: 1.16 per 10 beats per minute; 95% confidence interval: 1.08–1.25) and retinopathy (adjusted hazard ratio: 1.11 per 10 beats per minute; 95% confidence interval: 1.02–1.21). Conclusion Patients with type 2 diabetes mellitus who have a higher resting heart rate experience a greater incidence of new-onset or progressive nephropathy and retinopathy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00145925. http://www.advance-trial.com/static/html/prehome/prehome.asp
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Affiliation(s)
- Graham S Hillis
- The George Institute for Global Health, University of Sydney, Australia.
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Hypotensive and heart rate-lowering effects in rats receiving milk fermented by specific Lactococcus lactis strains. Br J Nutr 2012; 109:827-33. [DOI: 10.1017/s0007114512002115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previous studies have demonstrated that milk fermented by specific Lactococcus lactis strains significantly inhibits the activity of angiotensin I-converting enzyme (ACE). However, the relationship between the ACE inhibitor and its in vivo action has revealed discrepancies. Therefore, the aim of the present study was to investigate the antihypertensive and heart rate (HR)-lowering effect of milk fermented by specific L. lactis in a murine model. Spontaneously hypertensive male rats (271 (SD14) g) were randomised into four treatment groups that were orally administered with milk fermented by L. lactis NRRL B-50 571 or L. lactis NRRL B-50 572 at 35 or 50 mg protein/kg body weight (BW), respectively. Further, two more groups were fed with different solutions as controls: a saline solution as the negative control and Captopril™ (40 mg/kg BW), a proven ACE inhibitor, as the positive control. Blood pressure and HR were monitored by the tail-cuff method before the treatments and at 2, 4, 6 and 24 h post-oral administration. The results demonstrated that milk fermented by L. lactis NRRL B-50 571 as well as by L. lactis NRRL B-50 572 presented an important systolic and diastolic blood pressure- and HR-lowering effect. Thus, milk fermented by specific L. lactis strains may present potential benefits in the prevention and treatment of CVD associated with hypertension in humans.
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Abstract
Resting heart rate represents a cardiovascular risk indicator and an important target of therapy in chronic heart failure and potentially in coronary artery disease. Clinical and experimental evidence suggests that sustained elevation of heart rate - independent of the underlying trigger - plays a causal role in the pathogenesis of vascular disease. Results of the SHIFT trial support the importance of heart-rate reduction with ivabradine for improvement of clinical outcomes in heart failure and confirm the role of heart rate as a risk factor for patients with severe left ventricular dysfunction. Results of the BEAUTIFUL trial show that patients with ischemic heart disease and a heart rate above 70 bpm exhibit an adverse prognosis concerning coronary events.
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Smolock EM, Ilyushkina IA, Ghazalpour A, Gerloff J, Murashev AN, Lusis AJ, Korshunov VA. Genetic locus on mouse chromosome 7 controls elevated heart rate. Physiol Genomics 2012; 44:689-98. [PMID: 22589454 DOI: 10.1152/physiolgenomics.00041.2012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Elevated heart rate (HR) is a risk factor for cardiovascular diseases. The goal of the study was to map HR trait in mice using quantitative trait locus (QTL) analysis followed by genome-wide association (GWA) analysis. The first approach provides mapping power and the second increases genome resolution. QTL analyses were performed in a C3HeB×SJL backcross. HR and systolic blood pressure (SBP) were measured by the tail-cuff plethysmography. HR was ∼80 beats/min higher in SJL compared with C3HeB. There was a wide distribution of the HR (536-763 beats/min) in N2 mice. We discovered a highly significant QTL (logarithm of odds = 6.7, P < 0.001) on chromosome 7 (41 cM) for HR in the C3HeB×SJL backcross. In the Hybrid Mouse Diversity Panel (58 strains, n = 5-6/strain) we found that HR (beats/min) ranged from 546 ± 12 in C58/J to 717 ± 7 in MA/MyJ mice. SBP (mmHg) ranged from 99 ± 6 in strain I/LnJ to 151 ± 4 in strain BXA4/PgnJ. GWA analyses were done using the HMDP, which revealed a locus (64.2-65.1 Mb) on chromosome 7 that colocalized with the QTL for elevated HR found in the C3HeB×SJL backcross. The peak association was observed for 17 SNPs that are localized within three GABA(A) receptor genes. In summary, we used a combined genetic approach to fine map a novel elevated HR locus on mouse chromosome 7.
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Affiliation(s)
- Elaine M Smolock
- Department of Medicine, Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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Hillis GS, Woodward M, Rodgers A, Chow CK, Li Q, Zoungas S, Patel A, Webster R, Batty GD, Ninomiya T, Mancia G, Poulter NR, Chalmers J. Resting heart rate and the risk of death and cardiovascular complications in patients with type 2 diabetes mellitus. Diabetologia 2012; 55:1283-90. [PMID: 22286552 PMCID: PMC4170780 DOI: 10.1007/s00125-012-2471-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/09/2012] [Indexed: 02/02/2023]
Abstract
AIMS/HYPOTHESIS An association between resting heart rate and mortality has been described in the general population and in patients with cardiovascular disease. There are, however, few data exploring this relationship in patients with type 2 diabetes mellitus. The current study addresses this issue. METHODS The relationship between baseline resting heart rate and all-cause mortality, cardiovascular death and major cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) was examined in 11,140 patients who participated in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) Study. RESULTS A higher resting heart rate was associated with a significantly increased risk of all-cause mortality (fully adjusted HR 1.15 per 10 bpm [95% CI 1.08, 1.21], p<0.001), cardiovascular death and major cardiovascular outcomes without adjustment and after adjusting for age and sex and multiple covariates. The increased risk associated with a higher baseline resting heart rate was most obvious in patients with previous macrovascular complications (fully adjusted HR for death 1.79 for upper [mean 91 bpm] vs lowest [mean 58 bpm] fifth of resting heart rate in this subgroup [95% CI 1.28, 2.50], p = .001). CONCLUSIONS/INTERPRETATION Among patients with type 2 diabetes, a higher resting heart rate is associated with an increased risk of death and cardiovascular complications. It remains unclear whether a higher heart rate directly mediates the increased risk or is a marker for other factors that determine a poor outcome.
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Affiliation(s)
- G S Hillis
- The George Institute for Global Health, King George V Building, Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia.
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Speranza L, Franceschelli S, Riccioni G. The biological effects of ivabradine in cardiovascular disease. Molecules 2012; 17:4924-35. [PMID: 22547315 PMCID: PMC6268753 DOI: 10.3390/molecules17054924] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 03/27/2012] [Accepted: 04/16/2012] [Indexed: 12/31/2022] Open
Abstract
A large number of studies in healthy and asymptomatic subjects, as well as patients with already established cardiovascular disease (CAD) have demonstrated that heart rate (HR) is a very important and major independent cardiovascular risk factor for prognosis. Lowering heart rate reduces cardiac work, thereby diminishing myocardial oxygen demand. Several experimental studies in animals, including dogs and pigs, have clarified the beneficial effects of ivabradine associated with HR lowering. Ivabradine is a selective inhibitor of the hyperpolarisation activated cyclic-nucleotide-gated funny current (If) involved in pacemaker generation and responsiveness of the sino-atrial node (SAN), which result in HR reduction with no other apparent direct cardiovascular effects. Several studies show that ivabradine substantially and significantly reduces major risks associated with heart failure when added to guideline-based and evidence-based treatment. However the biological effect of ivabradine have yet to be studied. This effects can appear directly on myocardium or on a systemic level improving endothelial function and modulating immune cell migration. Indeed ivabradine is an 'open-channel' blocker of human hyperpolarization-activated cyclic nucleotide gated channels of type-4 (hHCN4), and a 'closed-channel' blocker of mouse HCN1 channels in a dose-dependent manner. At endothelial level ivabradine decreased monocyte chemotactin protein-1 mRNA expression and exerted a potent anti-oxidative effect through reduction of vascular NADPH oxidase activity. Finally, on an immune level, ivabradine inhibits the chemokine-induced migration of CD4-positive lymphocytes. In this review, we discuss the biological effects of ivabradine and highlight its effects on CAD.
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Affiliation(s)
- Lorenza Speranza
- Department of Medicine and Science of Aging, University G. d'Annunzio, 66123 Chieti, Italy.
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Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlöf B, Devereux RB. Effect of changing heart rate during treatment of hypertension on incidence of heart failure. Am J Cardiol 2012; 109:699-704. [PMID: 22154318 DOI: 10.1016/j.amjcard.2011.10.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022]
Abstract
An elevated heart rate (HR) at rest at baseline is associated with an increased risk of incident heart failure (HF) and with greater cardiovascular event rates in patients with chronic HF. However, despite the high attributable risk of hypertension for HF, whether the in-treatment HR predicts incident HF in patients with treated hypertension has not been evaluated. The HR was evaluated on annual electrocardiograms from 9,024 patients with hypertension without HF who were treated with losartan- or atenolol-based regimens. During a mean follow-up of 4.7 ± 1.1 years, HF developed in 285 patients (3.2%). On multivariate Cox analyses adjusted for randomized treatment, the baseline risk factors for HF, baseline and in-treatment blood pressure, QRS duration, and electrocardiographic left ventricular hypertrophy, a greater in-treatment HR predicted a 45% greater adjusted risk of new HF for every 10-beats/min increase in the HR (95% confidence interval [CI] 34% to 57%) or a 159% greater risk of HF in patients with the persistence or development of a HR of ≥84 beats/min (95% CI 88% to 257%). In contrast, with adjustment for the same covariates, the baseline HR as a continuous variable was a significantly less powerful predictor of new HF (hazard ratio 1.15 per 10 beats/min, 95% CI 1.03 to 1.28) and a baseline HR of ≥84 beats/min did not predict new HF (hazard ratio 1.00, 95% CI 0.63 to 1.58). In conclusion, a greater in-treatment HR on the serial electrocardiograms predicts a greater risk of incident HF during antihypertensive treatment, independent of the covariates, in patients with hypertension with electrocardiographic left ventricular hypertrophy. These findings support serial HR assessment to improve the risk stratification of patients with hypertension.
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Affiliation(s)
- Peter M Okin
- Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
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Bauman WA, Korsten MA, Radulovic M, Schilero GJ, Wecht JM, Spungen AM. 31st g. Heiner sell lectureship: secondary medical consequences of spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18:354-78. [PMID: 23459498 PMCID: PMC3584784 DOI: 10.1310/sci1804-354] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Persons with spinal cord injury (SCI) have secondary medical consequences of paralysis and/or the consequences of extreme inactivity. The metabolic changes that result from reduced activity include insulin resistance with carbohydrate disorders and dyslipidemia. A higher prevalence of coronary artery calcification was found in persons with SCI than that in matched able-bodied controls. A depression in anabolic hormones, circulating testosterone and growth hormone, has been described. Adverse soft tissue body composition changes of increased adiposity and reduced skeletal muscle are appreciated. Immobilization is the cause for sublesional disuse osteoporosis with an associated increased risk of fragility fracture. Bowel dysmotility affects all segments of the gastrointestinal tract, with an interest in better defining and addressing gastroesophageal reflux disease and difficulty with evacuation. Developing and testing more effective approaches to cleanse the bowel for elective colonoscopy are being evaluated. The extent of respiratory dysfunction depends on the level and completeness of SCI. Individuals with higher spinal lesions have both restrictive and obstructive airway disease. Pharmacological approaches and expiratory muscle training are being studied as interventions to improve pulmonary function and cough strength with the objective of reducing pulmonary complications. Persons with spinal lesions above the 6th thoracic level lack both cardiac and peripheral vascular mechanisms to maintain blood pressure, and they are frequently hypotensive, with even worse hypotension with upright posture. Persistent and/or orthostatic hypotension may predispose those with SCI to cognitive impairments. The safety and efficacy of anti-hypotensive agents to normalize blood pressure in persons with higher level cord lesions is being investigated.
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Affiliation(s)
- William A Bauman
- VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center , Bronx, New York ; Medical Service, James J. Peters VA Medical Center , Bronx, New York ; Department of Medicine, The Mount Sinai School of Medicine , New York, New York ; Department of Rehabilitation Medicine, The Mount Sinai School of Medicine , New York, New York
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Rosado-Rivera D, Radulovic M, Handrakis JP, Cirnigliaro CM, Jensen AM, Kirshblum S, Bauman WA, Wecht JM. Comparison of 24-hour cardiovascular and autonomic function in paraplegia, tetraplegia, and control groups: implications for cardiovascular risk. J Spinal Cord Med 2011; 34:395-403. [PMID: 21903013 PMCID: PMC3152811 DOI: 10.1179/2045772311y.0000000019] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Fluctuations in 24-hour cardiovascular hemodynamics, specifically heart rate (HR) and blood pressure (BP), are thought to reflect autonomic nervous system (ANS) activity. Persons with spinal cord injury (SCI) represent a model of ANS dysfunction, which may affect 24-hour hemodynamics and predispose these individuals to increased cardiovascular disease risk. OBJECTIVE To determine 24-hour cardiovascular and ANS function among individuals with tetraplegia (n=20; TETRA: C4-C8), high paraplegia (n=10; HP: T2-T5), low paraplegia (n=9; LP: T7-T12), and non-SCI controls (n=10). Twenty-four-hour ANS function was assessed by time domain parameters of heart rate variability (HRV); the standard deviation of the 5-minute average R-R intervals (SDANN; milliseconds/ms), and the root-mean square of the standard deviation of the R-R intervals (rMSSD; ms). Subjects wore 24-hour ambulatory monitors to record HR, HRV, and BP. Mixed analysis of variance (ANOVA) revealed significantly lower 24-hour BP in the tetraplegic group; however, BP did not differ between the HP, LP, and control groups. Mixed ANOVA suggested significantly elevated 24-hour HR in the HP and LP groups compared to the TETRA and control groups (P<0.05); daytime HR was higher in both paraplegic groups compared to the TETRA and control groups (P<0.01) and nighttime HR was significantly elevated in the LP group compared to the TETRA and control groups (P<0.01). Twenty-four-hour SDANN was significantly increased in the HP group compared to the LP and TETRA groups (P<0.05) and rMSSD was significantly lower in the LP compared to the other three groups (P<0.05). Elevated 24-hour HR in persons with paraplegia, in concert with altered HRV dynamics, may impart significant adverse cardiovascular consequences, which are currently unappreciated.
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Affiliation(s)
- John R Teerlink
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Mao Q, Huang JF, Lu X, Wu X, Chen J, Cao J, Li J, Gu D. Heart rate influence on incidence of cardiovascular disease among adults in China. Int J Epidemiol 2010; 39:1638-46. [DOI: 10.1093/ije/dyq119] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Okin PM, Kjeldsen SE, Julius S, Hille DA, Dahlof B, Edelman JM, Devereux RB. All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy. Eur Heart J 2010; 31:2271-9. [DOI: 10.1093/eurheartj/ehq225] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Current world literature. Curr Opin Cardiol 2010; 25:411-21. [PMID: 20535070 DOI: 10.1097/hco.0b013e32833bf995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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